The nasal septum is the vertical wall that divides the nose into two nasal cavities. It is made up of cartilage (septal cartilage) in the front, and bone in the back. The nasal cavities and nasal septum are lined with a thin membrane of tissue called mucosa (mucous lining tissue).
A deviated septum will block one side of the nose or both. It may also block the drainage system of the sinuses or have a “bone spur” that is impacted into the nasal tissue causing headaches.
Most septal deformities result in no symptoms, and you may not even know you have a deviated septum. Some septal deformities, however, may cause the following signs and symptoms:
Signs & Symptoms of a Deviated Septum
- Nosebleeds. The surface of your nasal septum may become dry, increasing your risk of nosebleeds.
- Obstruction of one or both nostrils. This obstruction can make it difficult to breathe through the nostril or nostrils. This may be more noticeable when you have a cold (upper respiratory tract infection) or allergies that can cause your nasal passages to swell and narrow.
- Noisy breathing during sleep. This can occur in infants and young children with a deviated septum or with swelling of the intranasal tissues.
- Facial pain. Though there is some debate about the possible nasal causes of facial pain, a severe deviated septum that impacts the inside nasal wall, when on the same side as one-sided facial pain, is sometimes considered a possible cause.
- Preference for sleeping on a particular side. Some people may prefer to sleep on a particular side in order to optimize breathing through the nose at night. This can be due to a deviated septum that narrows one nasal passage.
- Awareness of the nasal cycle. It is normal for the nose to alternate being obstructed on one side, then changing to being obstructed on the other. This is called the nasal cycle. The nasal cycle is a normal phenomenon, but being aware of the nasal cycle is unusual and can be an indication that there is an abnormal amount of nasal obstruction.
Possible Causes of a Deviated Septum
- A condition present at birth. In some cases, a deviated septum occurs during fetal development and is apparent at birth.
- Injury to the nose. A deviated septum can also be the result of an injury that causes the nasal septum to be moved out of position. In infants, such an injury may occur during childbirth. In children and adults, a wide array of accidents may lead to a nose injury and deviated septum — from tripping on a step to colliding with another person on the sidewalk. Trauma to the nose most commonly occurs during contact sports, active play or roughhousing, or automobile accidents.
The normal aging process may affect nasal structures, worsening a deviated septum over time. Also, changes in the amount of swelling of nasal tissues, because of developing rhinitis or rhinosinusitis, can accentuate the narrowing of a nasal passage from a deviated septum, resulting in nasal obstruction.
Initial treatment of a deviated septum may be directed at managing the symptoms of the tissues lining the nose, which may then contribute to symptoms of nasal obstruction and drainage. Your doctor may prescribe:
- Decongestants reduce nasal tissue swelling, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray.
- Antihistamines help prevent allergy symptoms, including obstruction and runny nose. They can also sometimes help nonallergic conditions such as those occurring with a cold.
- Nasal steroid sprays Prescription nasal corticosteroid sprays can reduce inflammation in your nasal passage and help with obstruction or drainage. It usually takes from one to three weeks for steroid sprays to reach their maximal effect, so it is important to follow your doctor’s directions in using them.
Surgery for a Deviated Septum
If you still experience symptoms despite medical therapy, you may consider surgery to correct your deviated septum (septoplasty).
Septoplasty is performed under general or local anesthesia. It takes about one hour and is performed as an outpatient procedure. It may be performed with other nasal or sinus procedures. A small incision is made inside the nose. The mucosal lining of the septum is detached from the cartilage and bones of the septum. The deviated portions of the septum are removed or straightened. Bone spurs if present are removed.
The nasal lining mucous membrane is sutured back together with dissolving suture. Nasal Splints are rarely used. With the septum sutured into place, nasal packing is usually not necessary. The septal sutures dissolve over 3 weeks time. Pain is mild to moderate especially at the front of the nose. Bleeding may occur during the first 2 weeks after surgery. Oozing is common the first 48 hours after surgery. If an infection occurs or if the healing is poor, a hole or perforation can occur. Nose blowing and strenuous exercise should be avoided for one week after surgery and irrigation with a sinus rinse kit is often recommended postoperatively.